Exam 2 Flashcards
What are the indications for suctioning?
- retained secretions
- visible secretions
- Increased PIP on vents
- decreased SpO2
- ineffective cough
What are the complications of suctioning?
MOST COMMON - hypoxemia
- airway trauma
- bronchospasm
- infection
- atelectasis
What is the frequency for suctioning?
AS NEEDED
( dependent on indications)
What is a normal suction pressure?
Infant
(-80) -> (-100)
Children
(-100) -> (-120)
Adult
(-120) -> (-150)
Sizes of the suction catheters
6,8,10,12,14,16
What is the equipment needed for suctioning?
- Step 1: assess pt.
What is the procedure for suctioning?
What are the indications CLOSED suctioning?
- HIGH PIP or HIGH FiO2
- High vent settings
What are ways to minimize atelectasis and trauma during suctioning?
- no longer than 15 seconds. Suction time
- pre-oxygenate pt.
- use correct size catheter
- avoid disconnection from vent
- limit negative pressure
- remain sterile
What are the contraindications for nasotracheal suctioning?
ABSOLUTE - epiglottitis and croup
- occluded nasal passage
- nasal bleeding
- acute head, facial, or neck injury
- bleeding disorder
- laryngospasm
- bronchospam
- MI
What are the indications for an artificial airway?
- airway compromise
- respiratory failure
- need to protect airway
- relief of upper airway obstruction
- facilitate of tracheal suctioning
What are the advantages of oral, nasal intubation, tracheostomy?
What is the purpose of Murphys eye, cuff, pilot balloon, length markings, radiopaque line, inner cannula, stylet?
Murphy’s eye - in case of obstruction (emergency hole)
Cuff - seals and protects lower airway
Pilot balloon - tells when cuff is inflated/deflated (monitor status of cuff)
Radiopaque line/depth markings - assists tube placement
Inner cannula - keeps trach clean and provides patent airway
Stylet - helps guide intubation
What is the position of ETT?
- 2-5cm above the carina
- between T2 and T4
What are the situations for a false capnometry or colorimetery?
(Exhaling CO2 is yellow)
- cardiac arrest intubations
- the color will not turn yellow
- will only change with good compressions
What is the treatment for post extubation stridor?
Racemic epinephrine
what factors are used to determine if a pt. Should be changed to a tracheostomy tube?
- projected time pt. Will need the artificial airway
- pts. Tolerance to ET tube
- pts. Overall condition
- pts. Ability to tolerate surgery
- > 21 days=3 weeks trach
What is the anatomy used for tracheostomy insertion?
2nd and 3rd tracheal rings
What are the injuries seen with tracheostomy tubes?
- tracheomalacia
- tracheal stenosis
- tracheal lesions
- Tracheoesophageal fistula
Uses of a T-tube vs. trach collar
- T-tube limits the patient from moving but tube moves more
- Trach collar allows patient to move more but the tube moves less
Wha are the reasons for increased infections with artificial airways?
- bypass upper airway filtration
- increased aspiration of pharyngeal secretions
- contaminated equipment or solutions
- impaired mucociliary clearance in trachea
- increased mucosal damage owing to tube or suctioning
- ineffective cough
What is a normal cuff size?
20 - 30cmH2O or 20 - 25mmHg
What are the effects of tube size on the cuff pressure?
- The smaller the cuff, the less of a seal. Infections can happen.
- the smaller the tube, the greater the resistance
What are the causes of tube obstruction?
- kinking of the tube
- herniating of the cuff over the tube tip
- obstruction of the tube opening against the tracheal wall
- mucus plugging
What are the steps to relieve tube obstruction?
- move pt. Head/neck
- deflate cuff
- attempt to pass suction catheter (shows location of obstruction)
TRACH - remove inner cannula and clean it
- RESTORE VENTILATION
What is the most common cause of an airway obstruction?
mucus plugging
How do we ventilate a pt. With a full laryngectomy?
- Bag and mask (peds mask)
- Bag over stoma
what is the upper airway anatomy?
Normally (nasopharynx)
Owen (oropharynx)
Takes (tongue)
Everyone (epiglottis)
Large (laryngopharynx)
Vegetables (vocal cord)
Like (larynx)
The (trachea)
Eggplan (esophagus)
What is a Maxillio Facial Injury and how do we intubate?
- injury of the oral section
- use a nasotracheal
How long do we suction?
no more than 15 seconds
